How would you approach a pT2 nonseminomatous testicular cancer, embryonal caricnoma with +LVI with persistent b-hcg < 20 post-operatively?  

If a patient has had an inguinal orchiectomy and has a persisting b-HCG in a reliable lab (remember that alpha-HCG can cross-react with the alpha chain of LH, so a "good" beta-HCG assay is important, especially as hypogonadal males often have an elevated LH), it suggests clearly that there is residu...

This patient presumably has normal imaging studies but persistent elevation of hCG levels, but below 20. He should be queried about marijuana use (preferably not with his parents in the room!). False positive hCG levels from marijuana was first reported by Dr. Marc Garnick, PMID 7421935 over 30 year...